Individual
MONGO ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M. ED
Contact information
Practice address
829 NW 142ND ST, EDMOND, OK 73013-1962
(405) 315-0855
Mailing address
829 NW 142ND ST, EDMOND, OK 73013-1962
(405) 242-3423
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
04/27/2013
Last updated
04/27/2013
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